Plan Types, Benefits & Enrollment Rules (AHIP 2026)

Study cheat sheet

This lesson provides an overview of Medicare Advantage (Part C) plans, explaining that they are offered by private insurers and must cover all Original Medicare benefits (Part A and Part B), often including Part D prescription drug coverage as MAPD plans. It details key features like the maximum out-of-pocket limit (MOOP) and supplemental benefits such as dental, vision, and hearing. The lesson covers coordinated care plans (HMOs and PPOs), including their network rules, referral requirements, and out-of-network coverage options, as well as Special Needs Plans (SNPs) designed for specific beneficiary groups. It also introduces Private Fee-for-Service (PFFS) plans and Medical Savings Account (MSA) plans, and discusses enrollment requirements, prescription drug coverage, employer/union plans, and enrollee protections like grievance and appeals processes.

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